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The participation of armed forces in humanitarian operations and in disaster response is common in many countries. In Brazil, the armed forces have had history in providing health support to victims in emergencies, which also includes the provision of pharmaceutical services (PS).

Problem:

Even though being essential for the provision of health care in disaster response, the preparedness of PS is not well-addressed in the literature. The use of a comprehensive approach to evaluate preparedness of PS in military institutions may subsidize preparedness measures. The goals of this work were to analyze the preparedness of PS for disaster response and humanitarian aid in military units of a Brazilian armed force institution, and to propose a framework to improve the preparedness of PS in operational medicine.

Methods:

An investigation of a cross-sectional design was performed. A logic model and indicators to evaluate preparedness of PS were applied. Data were obtained from official documents, interviews with key stakeholders, and observation of good storage practices (GSP).

Results:

Identified were: lack of specific budget for medicine procurement in case of disaster, absence of emergency stockpile, proper means for medicine transportation, and records of trained health professionals. An emergency plan, a list of selected medicines, adaptable mobile health care units, and a system for mobilization of health professionals were some of the positive aspects recognized. Different aspects for improvement were acknowledged and recommendations to favor the efficiency and the quality of PS in emergencies were proposed.

Conclusions:

The investigation provided valuable results for the planning and execution of responses to disasters and humanitarian aid. The findings and proposed recommendations may be useful for other military organizations similar to those in Brazil.

Pharmaceutical services for public health emergencies, such as the Zika virus (ZIKV) epidemic, are relevant for service effectiveness in the Brazilian health system. Pharmacists can act strategically in risk reduction. However, official guidelines do not consider pharmaceutical services when approaching health emergencies.

Aim:

To identify and understand primary healthcare pharmacist interventions in risk reduction for the recent ZIKV epidemic in Brazil.

Methods:

The study took place in Campo Grande, Mato Grosso do Sul, in November 2017. A semi-structured questionnaire was developed, including general issues related to knowledge of Zika, risk communication, and the pharmacist's role in patient care for ZIKV disease. The instrument was pre-tested. Primary healthcare center (PHC) pharmacists were subsequently interviewed. Aspects related to knowledge, risk reduction measures, and role were categorized and analyzed. The project received approval from the Institutional Review Board (IRB) at the Sergio Arouca National School of Public Health.

Results:

Forty-two of the 48 PHC pharmacists in Campo Grande were interviewed. Risk reduction measures were cited by most interviewees. Among these strategies, 92% were collective measures, such as making information available for the population (30%) and for the health workers (8%), and vector control strategies (43%). Use of mosquito nets was the most cited individual risk-reduction strategy. Only one pharmacist cited risk for pregnant women and suggested birth control as a strategy. Another pharmacist pointed to ZIKV “treatment.” No interviewee mentioned measures related to preparedness of pharmaceutical services.

Discussion:

PHC pharmacists do not place themselves at the frontline of risk reduction for the ZIKV epidemic. In the face of potential hazards and consequences of this disease, action by pharmacists is deemed critical. This study highlights pharmacist's misconceptions and lack of focused knowledge, pointing to the need for training and capacity-building in order to increase quality of care and positive management of future epidemics.

In Brazil, poverty-stricken population groups were the most affected by Zika virus (ZIKV). Women and children are fragile links that need focused attention, especially in relation to health care.

Aim:

To investigate vulnerable, at-risk women in relation to their awareness of the ZIKV infection knowledge about the disease.

Methods:

With evidence-based risk communication literature and consequences of ZIKV infection, a data collection instrument with open-ended questions was developed. Women from a small municipality in west-central Brazil, most from a rural setting, were interviewed at primary health care centers in April 2018. Interviews were recorded and transcribed. A preliminary analysis ensued.

Results:

Forty women were interviewed. The average age was 42.3 (21-74 yrs) and 39 women had at least one child. The average number of people living in the same home was 3.8 (1-18) and 24 homes (60%) had one to four children. Fourteen women (54%) were beneficiaries of income supplementation programs. Two interviewees mentioned they had never heard of Zika and eight (20%) had no actual knowledge to convey. Other groups had some knowledge about ZIKV. Fifteen (37.5%) associated ZIKV with mosquito bites and another 15 with pregnancy or birth defects. Ten women (25%) mentioned dengue or chikungunya, but only 7 (17.5%) were aware of symptoms. Only eleven women (27.5%) declared public health workers as information sources.

Discussion:

Positive aspects of awareness and knowledge were the tentative relationship some women made between pregnancy risk and exposure to mosquitoes, and with dengue or chikungunya. However, given ample media coverage and the severity of the epidemic, it is noteworthy to point out that all aspects were mentioned by fewer than half of the women. Health workers were not represented as relevant sources of information. Future in-depth content analysis of interviews may reveal important issues for risk communication strategies for this population.

Military participation in humanitarian operations, both in cases of armed conflict and in response to natural disasters, is a common phenomenon in several countries. In Brazil, the Armed Forces have a history in providing humanitarian assistance to victims of emergencies through their field hospitals, such as medical and dental care, laboratory and imaging diagnosis, and pharmaceutical services.

Aim:

To verify pharmaceutical services preparedness of military units in an institution of Brazilian Armed Forces to disaster response and humanitarian aid.

Methods:

A transversal study was carried out. The methodological approach was based on a logical model and indicators related to the preparedness of pharmaceutical services. Field research was carried out and good storage practices were investigated in loco. Key stakeholders were interviewed based on an open-ended questionnaire on the preparedness of pharmaceutical services. Interviews were transcribed and analyzed for overall content, according to analytical categories stemming from the literature and indicators prior defined.

Results:

Key stakeholders of three military units were interviewed, and official documents and guidelines were also analyzed. Some pronounced shortcomings were identified, such as the lack of a specific budget for medicines management, no surplus of health supplies, lack of appropriate transports, and need of capacity building of health professionals and support team. The existence of a disaster plan, selection of essential medicines for primary reaction, forecasting of medicines, field hospitals as mobile and adaptable health structures, and a system for military mobilization are some of the strengths identified. Two military units are better structured in the management of pharmaceutical service. The third unit still needs to mature its processes to fit the health purposes of its mission.

Discussion:

These findings can subsidize the improvement of pharmaceutical services’ efficiency and quality in means of providing better response in emergency situations supported by the Brazilian Armed Forces.

The Zika virus (ZIKV) infection outbreak in Brazil surged in late 2014, peaking in 2015. The most affected region was the northeast, but Rio de Janeiro was especially affected in poor, vulnerable, low-income communities with inadequate sanitation and water. Most cases of the ZIKV-related neurologic syndrome, microcephaly, were detected among newborns coming from this environment.

Aim:

To identify risk perception and consequences of ZIKV infection for pregnant women in a vulnerable community in Rio de Janeiro.

Methods:

Forty women who frequented a primary health care center (PHC) in a ZIKV-prone area of Rio de Janeiro were interviewed based on an open-ended questionnaire on ZIKV infection and risk. No censorship regarding age or other demographic characteristics was applied. Interviews were transcribed and analyzed according to analytical categories stemming from the literature and prior work. Preliminary analysis focused on risks for pregnant women and other groups.

Results:

Absolute number of responses reflect density of issues within all responses. Age range was 15-60 years. Several women identified microcephaly as a consequence of ZIKV infection for newborns, but many respondents did not cite any health problem associated with ZIKA in pregnancy. Although some cited pregnant women and children as most vulnerable, people living in or near insalubrious environments, such as the elderly, and those with low immunity were more cited. Information was mostly obtained from health professionals and television. Many confused origin and symptoms of ZIKV infection with other arbovirus infections.

Discussion:

This vulnerable group of women, who continuously attend a PHC in the area, have had community experience with the disease and its consequences, showed surprisingly little knowledge as to the risks of ZIKV infection for pregnant women. Results may indicate that the health system has still not achieved adequate risk communication for at-risk women for ZIKV infection in Rio de Janeiro.

Disasters are a major challenge for public health because of damage caused by death, injury, or illness that exceeds health services’ ability to respond. Health professionals and students require awareness and understanding of particular aspects of disaster planning, mitigation, response, or recovery. In Brazil, despite the increase in the number and intensity of disasters, there is no formal acceptance regarding the need to integrate disaster content into curriculum guidelines (1)

Aim:

To develop and test referential and models for disaster management health professional education.

Methods:

Competence-based education has been proposed. The methodology adopted was developed by the Association (2) and adapted to be used in the Brazilian context. An initial literature search was performed in MEDLINE via PubMed, Google Scholar, Lilacs, and Scielo databases using disaster and competencies as descriptors.

Results:

Articles and documents in Portuguese, Spanish, and English were identified for: public health (21), nursing (20), multi-professional (16), psychology (4), pharmacy (4), dentistry (2), medicine (1), veterinary (2), and nutrition (1). Data were organized according to a proposal from the literature (3) Selection of benchmarks for the preparation of education models identified 27 referential, three of them developed in Brazil.

Discussion:

Application and evaluation of the methodology developed with undergraduate students of the Federal University of Rio Grande do Sul consisted of an initiative to prepare health care professionals for disaster management.

Pharmacists’ participation in health care within multi-disciplinary teams in Humanitarian Assistance (HA) shall be encouraged. Limited literature exists on their role in the humanitarian context. The objective of this paper is to evidence the skill-specific, comprehensive core competencies that pharmacists must demonstrate working in humanitarian interventions.

Methods

The literature search laid the groundwork for the development of interview guides and further analysis of the data. Semi-structured interviews were conducted with expatriate pharmacists and medical coordinators, all of whom have worked in the field of HA. The interviews were recorded, transcribed, and analyzed using a content analysis methodology.

Results

Three pharmacists and three medical coordinators were interviewed, who had worked in a combined 32 humanitarian missions. The main functions of pharmacists were focused on stock management and supply of medicinal products. However, pharmacists in HA did not perform many functions related to the provision of effective medication therapy management (MTM). A core competency framework for pharmacists working in the humanitarian field was created, which reflects the personal and technical competencies that are essential to work in HA.

Conclusion

Self-management in a pressured and changing environment, the ability to adapt to changing situations, and planning, prioritizing, and performing tasks well under pressure are the skills required for pharmacists and for any other humanitarian health worker. The results highlight great efforts being dedicated to pharmaceutical product supply and management by pharmacists working in HA.

Regardless of the capacity of the health care system of the host nation, mass gatherings require special planning and preparedness efforts within the health system. Brazil will host the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympics. This paper represents the first results from Project “Prepara Brasil,” which is investigating the preparedness of the health sector and pharmaceutical services for these events.

Hypothesis/Problem

This study was designed to identify the efforts engaged in to prepare the health sector in Brazil for the FIFA World Cup 2014 event, as well as the 2016 Summer Olympics.

Methods

Key informant interviews were conducted with representatives of both the municipality and hospital sectors in each of the 12 host cities where matches will be played. A semi-structured key informant interview guide was developed, with sections for each type of participant. One of each municipality's reference hospitals was identified and seven additional general hospitals were randomly selected from all of the inpatient facilities in each municipality. The interviewers were instructed to contact a reference hospital, and two of the other hospitals, in the jurisdiction for participation in the study. Questions were asked about plans for mass-gathering events, the interaction between hospitals and government officials in preparation for the World Cup, and their perceptions of their surge capacity to meet the potential demands generated by the presence of the World Cup events in their municipalities.

Results

In all, 11 representatives of the sampled reference hospitals, and 24 representatives of other general private and public hospitals in the municipalities, were interviewed. Most of the hospitals had some interaction with government officials in preparation for the World Cup 2014. Approximately one-third (34%) received training activities from the government. Fifty-four percent (54%) of hospitals had no specific plans for communicating with the government or other agencies during the World Cup. Approximately half (51%) had plans for surge capacity during the event, but only 27% had any surge capacity for isolation of potentially infectious patients.

Conclusion

Overall, although there has been mention of a great deal of planning on the part of the government officials for the World Cup 2014, hospital surge to meet the potential increase in demand still falls short.

The species of Glycerella share a prostomium with four rings bearing four distal appendages, and proboscis with rod-like aileron. They also have the first two parapodia uniramous, while the following are biramous, with dorsal and ventral cirri; the notopodia bear simple capillaries chaetae. The neuropodia are provided in the upper part with compound spinigerous chaetae while those in the lower part are falcigerous. Glycerella magellanica has been reported in the south-west Indian Ocean, south and north-west Pacific Ocean, and north and central Atlantic Ocean. Herein, the first record of this species is reported in the south-west Atlantic, specifically off the north-east coast of Rio de Janeiro, in the Campos Basin. A single specimen of this species was collected during the ECOPROF project coordinated by CENPES/PETROBRAS, although this species has been recorded elsewhere in muddy sediments. In this study the specimen was collected in a dead fragment of the coral Solenosmilia variabilis, at 745 m depth. Morphologically the specimen is very similar to that used in the original description. However, some morphological differences were found related to the appearance of the compound chaetae and aileron. These differences may indicate either that in the original description these features were overlooked, or rather a case of intra-specific variation.

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